Distribution of bacteria infected by metagenomic sequencing technology in maxillofacial space / 华西口腔医学杂志

OBJECTIVES@#This study aimed to compare and analyze the consistency and difference between metageno-mic next-generation sequencing (mNGS) and conventional bacterial culture in the detection of pathogenic microorganisms in maxillofacial space infection, as well as to provide a new detection method for the early clinical identification of pathogenic bacteria in maxillofacial space infection.@*METHODS@#The clinical data of 16 patients with oral and maxillofacial space infections in the First Affiliated Hospital of Zhengzhou University from March 2020 to June 2020 were collected. mNGS and conventional bacterial culture methods were used to detect pus. We then analyzed and compared the test results of the two methods, including the test cycle, positive detection rate, anaerobic bacteria, facultative anaerobes and aerobic bacteria detection rates, distribution of pathogenic bacteria, relative species abundance, and resistance genes.@*RESULTS@#The average inspection period of mNGS was (18.81±3.73) h, and the average inspection period of bacterial culture was (83.25±11.64) h, the former was shorter than the latter (@*CONCLUSIONS@#Compared with conventional bacterial culture, mNGS has the characteristics of short test time, high sensitivity, and high accuracy. Thus, it is a new detection method for the early identification of pathogenic bacteria in maxillofacial space infection and is beneficial to the early clinical diagnosis and treatment of the disease.

Clinical research of vacuum sealing drainage combined with artificial dermis for the treatment of ankle and foot soft tissue defects / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effect of vacuum sealing drainage (VSD) combined with artificial dermis for treatment of the ankle and foot soft tissue defects.</p><p><b>METHODS</b>A total of 15 patients with skin and soft tissue defect of ankle and foot were treated from January 2011 to December 2013, including 10 males and 5 females, with an average age of 32.5 years old ranging from 3 to 55 years old, involving 8 cases by traffic accident, 2 cases by machine accident, 5 cases by crush injury;8 cases with soft tissue exposure, 2 cases with tendor exposure, 5 cases with bone exposure. VSD was used to cover the wounds and continuous negative pressure drainage after debridement, the wounds covered with artificial dermis after the second granulation tissue grew well, again VSD was used to cover the wounds and negative pressure suction was applied, after 7 to 14 days negative pressure closed drainage was removed, free skin graft was transplanted above the artificial dermis, sterile gauze was used to compression bandage.</p><p><b>RESULTS</b>All cases were followed up for 3 to 14 months with an average of 6.5 months. Skin graft of 15 of patients survived after transplantation, artificial dermis graft interval was 7 to 14 days with an average of 9.5 days. There was no obvious scar hyperplasia and contracture, no obvious pigmentation, appearance and functional recovery.</p><p><b>CONCLUSIONS</b>After the implantation of artificial dermis and traditional skin graft method need for 2 to 3 weeks, vacuum sealing drainage technique combined with artificial dermis in treatment of soft tissue defect of foot and ankle skin has advantages of simple operation, significantly shorten the time of the second phase of the skin, without flap to repair, little injury to donor skin area, wound healing quality high, clinical effect of satisfaction.</p>

Case-control study on therapeutic effects of different fixation methods for the treatment of olecranon fracture / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects by comparing three different fixation methods: tension band, hollow lag screw and anatomical plate.</p><p><b>METHODS</b>From January 2010 to January 2012, 82 patients with olecranon fractures who underwent surgical treatments were followed-up. All the patients were divided into three groups: tension band fixation group (group A), hollow lag screw fixation group (group B), anatomical plate fixation (group C). In group A, there were 35 patients, including 19 males and 16 females, ranging in age from 32 to 49 years old, with an average of (43.6 ± 8.7) years old, and the patients were treated with tension band fixation. According to Colton classification, there were 5 cases of type I, 3 cases of type II A,19 cases of type II B, and 8 cases of type II C in group A. Among 20 patients in group B, there were 13 males and 7 females, ranging in age from 27 to 50 years old, with an average of (41.5 ± 9.3) years old. The patients in group B were treated with hollow lag screw fixation. According to Colton classification, there were 4 cases of type I, 4 cases of type II A, and 12 cases of type II B in group B. In group C, there were 27 patients totally, including 15 males and 12 females, ranging in age from 30 to 55 years old, with an average of (38.2 ± 6.2) years old. The patients in group C were treated with anatomical plate fixation. According to Colton classification, there were 4 cases of type II B, 13 cases of type II C, and 10 cases of type II D in group C. The Fracture healing time, complications and functional recovery were retrospectively observed and recorded.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 8 to 24 months, with an average of 15 months. The average healing time of patients in group C was the longest among three groups. The flexion-extension and rotation activities of elbow joint in group B and C were better than that in group C. According to Broberg & Morrey score system, the therapeutic effects of patients in group A and B were better than that of group C. In group C, 2 patients had incision infections, 6 patients complained of foreign body sensation, 1 patient got a delayed fracture healing, and 1 patient had the heterotopic ossification. There were no occurrences of incision infections in group A and B; internal fixation loosening occurred in 3 patients in group A and 2 patients in group B; delayed fracture healing occurred in 2 patients in group A and 2 patients in group B; and skin bursa formation occurred in 6 patients in group A and 1 patient in group B.</p><p><b>CONCLUSION</b>All the three ways are effective methods for the treatment of olecranon fractures. Fixation methods should be selected depending on the type of fracture.</p>

Discectomy and discectomy plus Coflex fixation for lumbar disc herniation, a clinical comparison study / 中华外科杂志

<p><b>OBJECTIVE</b>To compare clinical efficacy between discectomy and discectomy plus Coflex fixation for lumbar disc herniation.</p><p><b>METHODS</b>From December 2007 to August 2008, 50 patients (31 males and 19 females) were treated by surgery of discectomy and discectomy plus Coflex fixation. The average age was 52.5 years (range, 30 - 72 years). There were 24 cases in the group of discectomy plus Coflex fixation and 26 cases in the group of discectomy. Preoperative and postoperative visual analogue scales (VAS), Japanese Orthopadic Association (JOA) and Oswestry disability index (ODI) were recorded, as well as radiological index. And use a paired t-test and one-way analysis of variance (one-way ANOVA) statistical method to evaluate the Coflex dynamic stabilization system in value in the treatment of lumbar disc herniation.</p><p><b>RESULTS</b>Both groups received significant improvement of JOA, ODI and VAS (t = -33.2 - 64.5, P < 0.01), but the group of discectomy was found with deterioration of ODI at last follow-up, 12 months after surgery 6.7 ± 1.5 to 10.2 ± 2.3 (t = -19.3, P < 0.05). The group of discectomy plus Coflex fixation was found with significant increase of height of dorsal intervertebral discs (HD), distance across the two adjacent spinous processes (DS), distance of intervertebral foramina (DIF) and spinal canal area(SA) (t = -34.4 - 4.5, P < 0.05). In contrast, the group of discectomy was found with significant decrease of HD, DS, DIF and SA (t = 3.4 - 52.8, P < 0.05). Coflex fixed group in HD, DIF, DS significant difference with simple discectomy group, with a statistically significant (F = 14.1 - 25.6, P < 0.05).</p><p><b>CONCLUSIONS</b>Both discectomy and discectomy plus Coflex fixation are apparently effective when treating lumbar disc herniation. Coflex can significantly increase the HD and DIF when used for lumbar disc herniation, and it has positive influence for keeping height of lumbar vertebral space and treating the nerve root symptom of lumbar disc herniation. Discectomy plus Coflex is better than pure discectomy in preventing lumbar degeneration.</p>

Mid-term outcomes of minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation for lower lumbar degenerative diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the mid-term clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw fixation for lower lumbar degenerative diseases.</p><p><b>METHODS</b>From April 2004 to December 2005, minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation was performed in a consecutive series of 43 patients, including 24 male and 19 female, aging from 38 to 71 years, with an average age of 49 years. The length of surgical incision was 3 cm. The operation level at L(3-4) were 3 cases, L(4-5) 27 cases, L(5)-S(1) 13 cases and no case was at multilevel. Clinical outcomes were assessed by ODI scores and JOA questionnaires before and after operation. Operation time, intraoperative blood loss, incision status and complications were recorded. Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and the degeneration of adjacent segments.</p><p><b>RESULTS</b>The mean operation time was 110 minutes, the mean blood loss was 150 ml and all the incisions were healed primarily. The follow-up time ranged from 36 to 58 months. The ODI scores decreased significantly from 60 ± 10 preoperatively to 12 ± 4 postoperatively (P < 0.01). The JOA scores were improved remarkably from 9.6 ± 2.2 preoperatively to 23.8 ± 2.0 postoperatively (P < 0.01) and the proportion with optimal effect was 86%. The ventral and dorsal heights of intervertebral disc were significantly higher than those before operation (P < 0.01). The fusion rate was 94%. The incidence of adjacent segment degeneration was 17%. There were no complications such as secondary scoliosis, screw loosening, internal fixation failure and cage slippage.</p><p><b>CONCLUSIONS</b>The minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation is an effective and convenient method with little surgical trauma. The mid-term follow up results showed favorable outcomes in patients receiving this surgery.</p>

A short-term follow-up results of lumbar disc herniation by Coflex / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the short term effectiveness of lumbar disc herniation by Coflex.</p><p><b>METHODS</b>From December 2007 to June 2008, 31 patients (16 males and 15 females) were treated by Coflex. The average age was 51.4 years (range, 33 - 70 years). The average period of follow-up was 10 months. To evaluate the short term effectiveness of lumbar disc herniation by Coflex by JOA, VAS, the conventional radiography and oswestry disability index (ODI).</p><p><b>RESULTS</b>The average JOA score increased from 9.1 +/- 1.1 preoperatively to 26.4 +/- 1.7 at 6 month postoperatively. ODI decreased from 24.7 +/- 4.8 preoperatively to averaged 4.5 +/- 1.1 at 6 months postoperatively. The VAS score decreased from 7.9 +/- 0.8 to 3.0 +/- 0.9. The clinical symptoms after operation were improved significantly. There were statistically significant differences between the preoperative and postoperative HD (height of dorso- intervertebral discs), DS(distance across the two adjacent spinous processes), DI (distance of intervertebral foramina). The average HD increased from (7.9 +/- 1.1) mm preoperatively to (10.8 +/- 1.3) mm after operation. The average DS increased from (28.3 +/- 2.4) mm preoperatively to (36.4 +/- 1.7) mm postoperatively. The average DI changed from (18.8 +/- 1.0) mm preoperatively to (21.6 +/- 1.7) mm postoperatively. Complications occurred in 3 patients (9.6%). One case complained of persistent low back pain. One case showed opposite lower limb pain in 3 weeks after operation, and was cured after appropriate treatment. One case had the loosening of Coflex in 6 months after surgery, but did not appear related clinical symptoms.</p><p><b>CONCLUSION</b>Coflex for lumbar disc herniation can increase the HD and DI significantly, and it has positive meaning for keeping height of lumbar vertebral space and treating the nerve root symptom of lumbar disc herniation.</p>

Coflex interspinous dynamic internal fixation for the treatment of degenerative lumbar spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To assess the clinical outcomes of Coflex interspinous dynamic internal fixation and the imaging changes for degenerative lumbar spinal stenosis.</p><p><b>METHODS</b>From October 2007 to February 2009, 30 patients with degenerative lumbar spinal stenosis were treated with Coflex interspinous dynamic internal fixation, including 17 males and 13 females with an average age of 45 years (range, 39 to 65 years). The operation level at L4,5 were 20 cases, L5S1 9 cases and 1 case was in both the two levels. The ODI scores and JOA questionnaires were assessed before and after operation. The radiological measurement included ventral and dorsal intervertebral space height, segmental intervertebral angles formed by lines drawn on the upper and lower endplates of the instrumented and adjacent levels on flexion-extension radiographs; the area of spinal canal, dural sac, the sagittal and transverse diameter of the spinal canal and dural sac on CT scan. All the patients were treated with limited laminectomy and were implanted with Coflex device.</p><p><b>RESULTS</b>All the patients were followed up for 5 to 19 months. There were significant differences in the ODI scores and the JOA questionnaires by paired t-test (P<0.01). All the patients were satisfied with surgical outcomes except 3 patients whose pain were not obviously relieved and need drugs or block therapy; 3 patient complaining of progressive hypoesthesia. There were no complications associated with the Coflex device. The height of dorso-intervertebral disc was increased obviously while the range of motion in adjacent levels was not increased on flexion-extension radiographs; the area of spinal canal and dural sac were significantly increased.</p><p><b>CONCLUSION</b>It shows a good clinical result to release the degenerative lumbar spinal stenosis symptoms and decrease short-term complications by using Coflex device. It is available for patients with increasing the intervertebral space, area of spinal canal and preventing the adjacent segment degeneration.</p>